The Development, Application and Analysis of an Enhanced Recovery Programme for Major Oesophagogastric Resection

J Gastrointest Surg. 2017 Apr;21(4):614-621. doi: 10.1007/s11605-017-3363-8. Epub 2017 Jan 24.

Abstract

Background: Enhanced recovery programmes improve outcomes in surgery, but their implementation after upper gastrointestinal resection has been limited. The aim of this study was to compare short-term outcomes for patients undergoing oesophagogastric surgery in an enhanced recovery programme (EROS).

Methods: EROS was developed after a multidisciplinary meeting by multiple rounds of revision. EROS was applied to all patients undergoing major upper GI resection at a university teaching hospital in the UK from 20/9/13, with data reviewed at 18/09/15. EROS was assessed to identify predictors for compliance.

Results: One hundred six patients underwent major upper GI resection including 81 oesophagectomies, 24 gastrectomies and 1 colonic interposition graft. Major complications (Clavien Dindo ≥3) occurred in 12 patients with 1 in-hospital death. Thirty-five patients (44%) were discharged on target day 8 of the EROS programme. Age and complications were independently associated with missing this discharge target.

Conclusion: Enhanced recovery is feasible and safe after major upper gastrointestinal surgery.

Keywords: Enhanced recovery; Gastrectomy; Oesophageal surgery; Oesophagectomy; Surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Colon / transplantation
  • Early Ambulation
  • Esophagectomy* / adverse effects
  • Female
  • Gastrectomy* / adverse effects
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Discharge
  • Perioperative Care / methods*
  • Program Development
  • Treatment Outcome